Kitap 3
6
But although the character of the fever, and of its remission, fixes the time for giving food and drink, yet it is not very easy to know when the patient has fever, when he is better, when he is becoming worse: without which food and drink cannot be administered. For the pulse upon which we mostly rely (III.4, 16) is a very deceptive thing, because often it is rendered slower or faster by age and by sex and by constitution. And very frequently when the body is fairly healthy, if the stomach is weak, also at times when a fever is beginning, the pulse is low and quiescent, so that possibly a patient may seem weak who will yet easily support the impending severe paroxysm. On the contrary, the bath and exercise and fear and anger and any other feeling of the mind is often apt to excite the pulse; so that when the practitioner makes his first visit, the solicitude of the patient who is in doubt as to what the practitioner may think of his state, may disturb the pulse. On this account a practitioner of experience does not seize the patient's forearm with his hand, as soon as he comes, but first sits down and with a cheerful countenance asks how the patient finds himself; and if the patient has any fear, he calms him with entertaining talk, and only after that moves his hand to touch the patient. If now the sight of the practitioner makes the pulse beat, how easily may a thousand things disturb it! Another thing which we put faith in, a sensation of heat, is equally fallacious: for it may be excited by hot weather, by work, by sleep, by fear, by anxiety. Such things also should be noted indeed, but not altogether relied on. And we know at once that he is not feverish, whose pulse is of natural regularity, and his warmth such as is customary in health: we must not, however, at once assume fever if there is heat and high pulse, but under the following conditions: if also the surface of the skin is dry in patches; if both the forehead feels hot, and it feels hot deep under the heart; if the breath streams out of the nostrils with burning heat; if there is a change of colour whether to unusual redness or to pallor; if the eyes are heavy and either very dry or somewhat moist; if sweat, when there is any, comes in patches; if the pulse is irregular. On this account the practitioner should not take his seat in a dark part of the room, nor at the patient's head, but he should face the patient in a good light, so that he may note all the signs from his face as he lies in bed. Now when there has been fever and it has decreased, one should observe whether the temples or other parts of the body are becoming a little moist, which is evidence that sweating is about to set in; and if there is any sign of it, then and not before hot water should be given to drink, of which the effect is salutary if it causes a general sweating all over the body. Now to promote this the patient should keep his hands well covered under the bed-clothes, and do the same with his legs and feet. But it is a mistake to torment patients with bed-clothes, as many do, at the very paroxysm of the fever, worst of all when it is an ardent fever. If the body begins to sweat, a linen towel should be warmed, and each part gradually wiped over. But when the sweating has quite ended, or if none has come, when the patient seems in the most fit state for food, he should be anointed lightly under the bedclothes, next wiped over, and then given food. For patients in fever, liquid food is best, or whatever approximates to fluid, and that of the lightest possible kind, barley gruel in particular; and if there have been high fevers, that should be of the thinnest. Honey also which has been freed from the comb may be correctly added to give the body more nutriment; not if it upsets the stomach this is unnecessary, as also is the gruel itself. But in its place can be given either crumbled bread or washed spelt groats in hot water; in hydromel if the stomach is firm and the bowels tight, or in vinegar and water if the former is weak and the latter loose. And indeed this will suffice for food on the first day; then on the next day some addition can be made, yet from the same class of food, either pot-herbs or shell-fish or orchard fruit. And whilst fevers are on the actual increase, this is the only suitable food; but when the fevers have subsided or abated, a beginning indeed is to be made always with something of the lightest kind, then something to be added of the middle class, regard being had throughout both to the patient's strength and to his disease. A variety of food may be placed before the patient as Asclepiades prescribed, only when he is troubled by loss of appetite, and insufficiency of strength, in order that by tasting a little of each he may avoid starvation. But if there is no lack of strength nor loss of appetite, the patient should not be tempted by a variety of food, lest he take more than he can digest. And there is no truth in what Asclepiades said, that a variety of food is more easily digested; for it is eaten more readily, but digestion depends upon what the food is, and how much. Nor is it safe for the patient to be filled up with food whilst there are great pains, nor during an increase of the malady, but only after his illness has turned towards improvement.
